心肌梗死患者心室重构演变及内分泌激素变化与神经内分泌拮抗剂的作用

Variation of ventricular remodeling,the changes of endocrine hormone and the role of the neuroendocrine antagonist in patients with myocardial infarction

目的:心肌梗死后交感神经系统和肾素-血管紧张素-醛固酮系统激活所导致的血浆中内分泌激素水平升高是促进心室重构发生的决定因素。观察联合应用神经内分泌拮抗剂对急性心肌梗死患者心室重构和血浆内分泌激素水平的影响。方法:选择2002-02/2003-02解放军总医院心血管内科住院的急性心肌梗死患者121例为观察对象。其中67例患者获得完整的资料,男58例,女9例,年龄38～75岁。入选患者病情相对稳定,无急性左心功能不全。均给予神经内分泌拮抗剂β受体阻滞剂+血管紧张素转换酶抑制剂联合治疗,分别在出院后3,6个月,1年时对患者进行超声心动图检查,测定左室舒张期末内径、左室收缩期末内径、左室舒张期末容积、左室收缩末期容积和左室射血分数;并于出院后6个月复查血浆内分泌激素水平。结果:进入结果分析急性心肌梗死患者67例。①出院后6个月急性心肌梗死患者血浆肾素、血管紧张素Ⅱ和去甲肾上腺素水平明显低于治疗前犤(2.03±2.07),(45.34±26.47),(0.40±0.29)ng/L;(1.22±1.79),(30.99±15.52),(0.48±0.32)ng/L,t=2.74.4.54,2.01,P<0.05～0.01犦。②患者出院后6个月及1年左室收缩期末内径明显小于治疗前犤(34.00±5.04),(34.31±4.89),(36.18±5.05)mm,t=3.32,2.02,P<0.01,0.05犦;出院后6个月左室收缩期末容积明显小于治疗前犤(53.48±22.67),(59.23±19.87)mL,t=2.51,P<0.01犦;出院后3,6个月,1年左室射血分数明显高于治疗前犤(55.90±8.72)%,(55.55±8.40)%,(55.05±7.57)%,(52.16±8.77)%,t=-2.95,-2.79,-2.01,P<0.05～0.01犦。结论:联合应用神经内分泌拮抗剂能有效降低血浆肾素、血管紧张素Ⅱ和去甲肾上腺素水平,这可能正是拮抗神经内分泌激素药物能够逆转和抑制心室重构的作用途径。

AIM:The increase of plasma level of endocrine hormone caused by the activatio n of sympathetic nervous system and rennin angiotensin aldosterone system af ter myocardial infarction is the determinant that promotes the occurrence of ven tricular remodelling.This paper aims to observe the influence of united applicat ion of neuroendocrine antagonist on the ventricular remodelling and plasma level of endocrine hormone in patients with acute myocardial infarction. METHODS:A total of 121 patients with acute myocardial infarction,who were hos pitalised in the Department of Cardiology of the General Hospital of Chinese PLA between February 2002 and February 2003,were taken as the observed subjects,and 67 cases(58 males and 9 females) at 38 to 75 years of age had complete data.The selected patients had relatively stable condition of illness,and had no acute l eft cardiac insufficiency.They all received treatment of neuroendocrin antagonis t beta receptor blocking agent plus angiotensin converting enzyme inhibitor,and they all received echocardiography,determinations of left ventricular end dias tolic diameter,left ventricular end systolic diameter,left ventricular end d iastolic volume,left ventricular end systolic volume and left ventricular ejec tion fraction at 3,6 and 12 months after discharge,and their plasma level of end ocrine hormone was re examined at 6 month after discharge. RESULTS:Sixty seven patients with acute myocardial infarction were involved in the analysis of results.① The plasma levels of rennin,angiotensin Ⅱ and n orepinephrine of the patients with acute myocardial infarction were obviously lo wer at 6 months after discharge than before treatment[(2.03 ± 2.07),(45.34± 26.47),(0.40± 0.29)ng/L;(1.22± 1.79),(30.99± 15.52),(0.48± 0.32)ng/L,t=2.74 ,4.54,2.01,P< 0.05 to 0.01].② The left ventricular end diastolic diameter of the patients was markedly smaller at 6 and 12 months after discharge than before treatment[(34.00± 5.04),(34.31± 4.89),(36.18± 5.05)mm,t=3.32,2.02,P< 0.01,0. 05];The left ventricular end systolic volume of the patients at 6 months after discharge was remarkably smaller than that before treatment[(53.48± 22.67),(59 .23± 19.87) mL,t=2.51,P< 0.01];The left ventricular ejection fraction was obvio usly higher at 3,6 and 12 months after discharge than before treatment[(55.90± 8.72)% ,(55.55± 8.40)% ,(55.05± 7.57)% ,(52.16± 8.77)% ,t=- 2.95,- 2.79 ,- 2.01,P< 0.05 to 0.01]. CONCLUSION:The united application of neuroendocrine antagonist can effectivel y decrease the plasma levels of rennin,angiotensin Ⅱ and norepinephrine,which may be exactly the role that neuroendocrine hormone drugs can reverse and inhibi t ventricular remodelling.